New SARS Outbreak Sparks 'Typhoid Mary' Fears

Singapore - Doctors still haven't pinned down exactly how a deadly flu-like virus is spreading and more cases are pointing to possible new ways it is using to pass from one victim to another.

A top Hong Kong health official said on Tuesday cockroaches might have spread the virus that causes Severe Acute Respiratory Syndrome (SARS) in an apartment complex in the city, leading to nearly 300 infections in a matter of days.

If proved true, it would represent an alarming development in the swiftly spreading epidemic in Hong Kong, a city of nearly seven million people filled with densely populated apartment buildings.

'That was how Aids was transmitted before it was discovered' Health officials are also looking at the possibility that SARS can be spread by a latter-day version of Typhoid Mary, a cook in early 20th century America who spread typhoid fever without showing symptoms herself.

SARS has killed more than 100 people and infected 2 750 worldwide since it surfaced in southern China late last year.

The World Health Organisation's infectious diseases chief said at the weekend he feared the SARS virus could be carried by people without symptoms.

"If there are people who have the virus and don't show symptoms, we are lost, because that would mean it had spread throughout the world, as it is easily contracted," David Heymann said in an interview with Spain's El Pais daily.

"That was how Aids was transmitted before it was discovered. We still don't know if this is the case, that's why we need a test," he added.

'Many persons who actually carry the virus may not be detected' The WHO said in an April 7 update published on their website that SARS diagnostic tests developed so far were problematic.

It said a test available for detection of SARS virus genetic material was useful in the early stages of infection. But it produced "many false-negatives, meaning that many persons who actually carry the virus may not be detected, creating a dangerous sense of false security."

This was the case for Fung Hong, the chief executive of a group of Hong Kong hospitals, who was confirmed with SARS early this week after originally testing negative for the virus.

This leaves open the possibility of more such cases and possible wrong diagnoses of patients showing some but not all the common symptoms, such as chills, high fever, body aches and breathing difficulties.

While the WHO has said the virus, new to science, has been isolated, little is known about it and there is no known cure.

"We don't know all the details of how the virus spreads. There's a limit to how much a country can prepare," said Dr David Bell on Tuesday. Bell is a Manila-based member of the WHO team dealing with SARS in East Asia.

SARS is highly contagious and doctors say it can easily be spread to others in close contact with ill patients through breathing in droplets from sneezing or coughing.

Touching door handles, lift buttons or water taps that have been contaminated by droplets from an infected persons' coughs or sneezes is another way to pass on the virus.

Bell said it was possible, but not yet proven, that the occasional person could be a carrier of SARS without suffering severe symptoms.

"It's quite likely it occurs but it's probably very unusual. There's no evidence. If that were common, it would be spreading right through the community like influenza or something like that, and the fact is it isn't," he added.

"All of the large outbreaks have been traced back to a person who had symptoms."

Singapore, which has imposed perhaps the most rigorous controls of any government in an affected area, now says SARS has spread to staff at five of the nation's six big hospitals.

After a lull in new cases, the island republic reported two deaths and seven new cases on Monday, its highest such numbers in two weeks. Eight people have died of SARS in Singapore.

Hong Kong, which has more than 900 cases and fears many more in coming weeks, is also trying to contain a new outbreak in one hospital and possibly a second.

A local councillor said on Tuesday the virus had spread to at least 14 housing estates in a densely populated new town that is home to hundreds of thousands of people.

But it is the rapid spread of SARS to residents of Amoy Gardens apartment complex in Hong Kong that has baffled and alarmed health officials and led to theories the virus could be airborne, spread through the water supply, or spread by cockroaches.

Cockroaches eyed as SARS spreads in Hong Kong

April 08 2003 at 08:06AM
By Tan Ee Lyn
IOL

Hong Kong - The deadly virus that triggers Severe Acute Respiratory Syndrome (SARS) has spread to another densely populated part of Hong Kong, and a top health official warned on Tuesday that cockroaches might be carrying the respiratory disease from apartment to apartment.

Residents from at least 14 housing estates in the suburban town of Tuen Mun had been infected, a district lawmaker said, raising fears that a disease which has killed 23 people in the territory is far from contained.

Deputy Director of Health Leung Pak-yin told a radio programme that cockroaches might have carried infected waste from sewerage pipes into apartments in another huge housing complex - Amoy Gardens - where more than a quarter of the city's 883 cases have occurred.

Health workers have confirmed that an infected man with kidney problems visited a relative in one Amoy Gardens block before the virus swept through the building like wildfire.

"The drainage may be the reason, it is possible that the cockroaches carried the virus into the homes," Leung said.

Doctors believe the virus is spread through droplets by sneezing and coughing or by direct contact. If it can be carried by cockroaches it would be even harder to contain.

Hong Kong, a territory of nearly seven million people, has the second highest number of infections in the world outside of mainland China, where it first emerged.

The infections in Tuen Mun were spread over a number of housing estates, district councillor Chan Wan-sang told Reuters. Half a million people live in Tuen Mun.

SARS symptoms include high fever and chills

"They are all from 14 different estates, but we believe the total number of people infected may be more than 14," he said.

Some of those infected in Tuen Mun were hospital staff and at least one caught it during a recent holiday to Beijing, he said.

About half of the 278 people infected in the Amoy Gardens estate come from one wing of a single block. Residents from that block have been evacuated and quarantined in isolation camps.

A government spokesperson said they would be allowed to return home from Thursday if they passed medical checks and government workers had disinfected drainage pipes in the estate.

The virus has been carried around the globe by travellers. It has killed more than 100 people and infected over 2 600 in 20 countries.

The epidemic is dealing a severe blow to the Hong Kong economy, which was just starting to show signs of recovery after two harsh downturns in the last five years.

Many travellers have cancelled trips to the city and residents are steering clear of usually crowded places like shopping malls and restaurants.

Continental Airlines was the latest to join a growing number of carriers cutting services. It suspended nonstop flights between New York and Hong Kong because of plunging demand.

SARS symptoms include high fever, chills and breathing difficulties.

The disease has a mortality rate of about four percent, far lower than influenza. But many Hong Kong patients quickly develop severe pneumonia which can require weeks in hospital.

Interestingly enough, I just spoke with an official at our county helath department to see if it was actually a confirmed case. He said no but that we have had 17 suspected cases since March 25th and this person meets much of the criteria.

Basically, he was in panic prevention mode. He tried to tell me that very close contact was needed with the person to become infected. I wasn't trying to appear argumentive or panicked or else I would have told him he really could not say that with much conviction, citing the Amoy Gardens as an example.

Never the less, I asked him what precautions were being taken to make sure our hospital staff's weren't infected and I asked him if the location of the victim would be made known...Ofcourse he said no and that close contact was needed with the victim and all close coontacts would be notified. The hospital and doctor's were on heightened alert. Blah, blah, blah

Well, just to confirm what we already knew..we're on our own.

CDC getting record calls on SARS

LAURA MECKLER, Associated Press Writer
Tuesday, April 8, 2003
(04-08) 10:25 PDT WASHINGTON (AP) --

The Centers for Disease Control and Prevention is receiving a record number of phone calls from members of the public concerning severe acute respiratory syndrome, the new contagious disease that has spread from Asia to the United States and elsewhere.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, told a Senate panel Tuesday the volume of daily calls sometimes exceeds 1,500. That's more than the CDC received even at the peak of the fall 2001 anthrax attacks, she said.

As of Monday, there were 148 suspected cases of SARS in the United States and more than 2,600 worldwide.

Testifying before the Senate appropriations health subcommittee, Gerberding said officials are working aggressively with airlines to determine appropriate procedures if a suspected SARS patient is on board a flight, including what protections are needed for workers on the plane and how the plane might be decontaminated.

She also said:

* The CDC is forming a communications team to make sure the agency is doing a good job communicating with the Asian community on SARS. Still, she said, they want to be sensitive to bias(sic), because this is not a disease of Asians but a disease of people who have been in the part of the world where SARS is spreading.

* CDC has three potentially useful tests to diagnose the virus, which CDC suspects is a new form of the coronavirus, which causes the common cold.

She said the U.S. cases, on average, may be less serious than those in other parts of the world because the CDC is using a very broad case definition in hopes of capturing all real cases. Someone doesn't have to have severe pneumonia to be listed as suspect SARS here, she said.

* While the health system in the United States "has risen to the occasion," other nations may not be responding as well to SARS. "It's going to be very difficult to contain it" as it spreads across the globe, she said.

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